เดินทางไกล [journey]

wanderlust

Friday, February 6, 2015

We’re back :) We had a
safe and easy trip from Bangkok to Tokyo, Tokyo to Los Angeles, and Los Angeles
to Atlanta!

Landed in America (LAX)!!

Big big plane

Heading to ATL!!!

No way we can count how many cups of coffee we've had...

We even had another Delta in-flight pharmacy moment! During a
conversation with one of the friendly flight attendants while we were taking a
chance to stand up and stretch our legs (trying to prevent a DVT!) we were able
to learn that she was recently diagnosed Graves’ Disease and answer many of the
questions she had. Kind of a long story, but it’s amazing how small talk can
lead to a meaningful connection. Just another thing to look back and smile
about!

Leaving Thailand was bittersweet and we spent lots of our time on the
plane rides and layovers reliving our trip with a slideshow of nearly 4,500
pictures and counting our blessings for all the experiences we received…

·Too many coffee frappes, scoops of ice cream,
cups of tea, and Thai sweets to count

…and thousands of smiles exchanged with
people from all over the world during our time in Thailand. It is no surprise
to us that this country is often referred to as the Land of Smiles!

America has its share of smiles too, and
none bigger than the ones on our faces when we were welcomed back in Atlanta by
our fabulous parents. We have missed our families so much. It is so good to be
home!

Now that we have reconnected with our
moms and had the chance to give them their surprise presents, we have two final
stories to share about our trip that we had to keep secret until now.

The first story is of Megan’s mom’s Thailand
gift. Mrs. Zeek collects nativities from the Zeek family’s travels all over the
world, and so it was our mission to find one for her in Thailand. The country
is over 95% Buddhist, so this posed quite a challenge. Luckily, our connection
with 1999 HSOP graduate Dr. Kelli Johnson led us to an adorable pottery shop in
Chiang Mai called Mengrai Kilns. Dr. Johnson knew about this shop from her
missionary friends. Mengrai celadons, or pottery, are made entirely by hand, one
piece at a time. No two pieces are the same. They are produced only in the
ancient city of Chiang Mai, so not only was purchasing this gorgeous Thai style
nativity an exciting accomplishment, but walking to the shop through the
historic streets of the Old City was a fun adventure! Megan has gently carried
the box set by hand on five different planes, and was thrilled to be able to give
her mom such a special present and genuine story. Mrs. Zeek was of course
thrilled too!

Surprise for Mrs. Zeek!

Pottery shop

Thai Nativity

Erin’s mom’s Thailand gift was also a very
special surprise. Shortly after Erin was born in Bangkok, her family moved to
Chiang Mai. In 1990, a man in the Night Bazaar by the name of Paradorn Threemake drew a picture of Erin and her brother, Bryan, with nothing but a
pencil. He is an incredible artist, and this likeness has hung in the McCreary
household foyer for 25 years! Before Erin left for this trip, she took a picture
of the drawing and the man’s name. Even though it had been so long, she had a
brief glimmer of hope that he would still be in the Chiang Mai night market.
Upon arriving in Chiang Mai, we set out the very first night to find him. Before leaving Mahasarakham, we had our friend
Boss write for us in Thai the phrase “have you seen the man that draws with
pencil?” Erin showed this piece of paper and the picture of her previous
drawing to every artist we encountered. Even though we stumbled across several
artists that first night, we were not successful. The second night, we explored
a different area of the market and found some men sketching. One of the men
read our note and looked up and said “Oh yes! He sits right over there!” We
could not believe this was happening…we had found him! When we walked to his
booth though, he wasn’t there. The other artists said he was at a dinner party
and to come back in a few hours. When we returned later, he still hadn’t
arrived but the artists assured us he was coming. We wandered around to shop
some more, and much to our surprise one of the artists had come to find us in
the market to tell us the man we sought had returned! It was so fun how the
entire section got into Erin’s story, and it was truly incredible to finally meet
this man. When Erin showed him the picture he had drawn 25 years ago, he was so
excited. We met him at 11PM on a Saturday, and by 10PM on Sunday he had drawn a
gorgeous picture of Erin, her brother, and her sister! Erin’s mom was
absolutely blown away by this gift, as she is super sentimental and misses life
in Thailand. It was hard for both of us to keep such juicy surprises, but we
are so glad we did and even happier to be able to bring home a piece of this
special country with us to share with our families.

Found the artist, 25 years later!!

Needless to say, the smiles on our faces
could not be any bigger. We will remember this trip forever and have definitely
changed for the better as a result of this experience. Thank you for following
along with us…we hoped you have learned, loved, and laughed as much as we have
throughout this journey! We will return one day so this is not the end. For
now, this is a pause to reflect on the past six weeks and look forward to the
rest of 2015 with a broad and radiant smile.

Tuesday, February 3, 2015

Monday morning we felt like local Bangkok students heading out to the last site of our International Pharmacy rotation here in Thailand at Roen-ya Pharmacy, an independent community pharmacy. After using google maps the night before to determine the approximate location of the pharmacy, we decided the best approach would be to take a taxi directly there. (Travel Tip for future students/travelers: If you use the maps application on your iPhone and drop a pin at the location then click the pin, the address pulls up in Thai and English. We used the screenshot of this to show the taxi driver and this made it very easy for the driver to understand where we wanted to go without us having to attempt to write in Thai). The taxi ride was very affordable (under $2...cheaper than us both buying BTS Sky Train passes!) and we arrived at the pharmacy located on the street corner, just on time at 9 AM despite the rush hour traffic.

As soon as we walked into Roen-ya, we were greeted by the pharmacist Dr. Katha and shown a place to sit while he provided medications and counseling to a few patients who walked in the doors behind us. We picked up right away that this is an exceptional pharmacy with the number of drug references and therapeutics resources lining the shelves, as well as prestigious pictures and awards in Dr. Katha’s office located in the back of the pharmacy. We were excited for what the two days would entail. After another pharmacist arrived, Dr. Katha was ready to speak to us. We spent the next few hours discussing the healthcare system in Thailand and Dr. Katha graciously shared his insights and impressive endeavors to improve direct patient care through community pharmacies in Thailand.

Library

Awards and Graduation photos

During our discussion with Dr. Katha, he emphasized that a huge burden on healthcare in Thailand, much like the United States, is the many patients with uncontrolled chronic conditions such as diabetes mellitus and dyslipidemia who end up requiring acute care at a hospital rather than receiving adequate primary care. He feels that the Health Promotion Hospitals (local outpatient clinics operated by nurses) that serve to provide primary care to local patients in the villages are not adequate for patients with chronic illnesses, because physicians and pharmacists only visit these Health Promotion Hospitals once a month. However, patients seek care at these health promotion hospitals because the district or provincial hospitals are inconvenient to get to and overcrowded, meaning the patients wait a long time and are rushed through their visit with the physician and pharmacists. These patients then only seek care at the larger hospitals when they are very ill. Dr. Katha even stated that the prescriptions patients have filled at a Health Promotion Hospital are simply ‘remade’ as only a pharmacist or physician has the expertise to truly ‘refill’ a prescription. Dr. Katha is very passionate about the role community pharmacies can play in caring for patients with common illnesses.

Inside of the pharmacy

However, Dr. Katha expressed that there is a major shortage of pharmacists who practice in community pharmacy to provide services to the public. Of the ~13,000 pharmacies in Thailand, only 5,000 actually have a pharmacist present in the facility, despite the new Good Pharmacy Practice Act and Quality Pharmacy Designation (hand symbol) that requires a pharmacist to be on site at all times. Dr. Katha's pharmacy has had this distinction for 12 years, which is as long as the program has been in place. Another problem is that these 5,000 pharmacies that do have a practicing pharmacist are mainly located in major cities, so majority of the community pharmacies in more rural areas of Thailand are without a pharmacist to dispense medications such as antibiotics. Dr. Katha contributes the lack of pharmacists entering into community practice to the pharmacy schools curriculum focus on hospital pharmacy practice. He explained that 2,000 students graduate pharmacy school in Thailand every year, but less than 10% go into community pharmacy. He stated that even though the major chain pharmacy in Thailand, Boots, offers huge financial incentives to community pharmacists, this has not been enough to increase the number of community pharmacists. This is a contrast to America, where we have many pharmacists in the community setting, but the limitation to patient care is lack of reimbursement for several clinical services that pharmacists can provide and lack of time available for pharmacists to perform these services. We are both excited about the future of provider status for pharmacists in the United States with the recent introduction of The Pharmacy and Medically Underserved Areas Enhancement Act within the House of Representatives and the Senate.

The Quality Pharmacist hand symbol

Pharmacists in the community can dispense this without a prescription

It was interesting and exciting to hear about the four special projects Dr. Katha, the former president of the Community Pharmacy Association in Thailand, has developed to engage in improving primary care from his own pharmacy. The first and largest project Dr. Katha and Roen-ya Pharmacy implemented was a smoking cessation program that began 12 years ago and has developed in the Thai Pharmacy Network on Tobacco Control. Dr. Katha was inspired after attending a conference at the University of Illinois-Chicago and came back to Thailand where he voluntarily collected data via a survey to determine the need for smoking cessation program and the willingness of patients to enroll. After receiving encouraging feedback, he then expanded to a pilot program with 15 community pharmacies providing counseling and free bupropion therapy to 76 smokers, of whom 30 successfully quit. With this data and the large need for smoking cessation across Thailand, which has 12 million smokers (half of whom are heavy smokers), Dr. Katha was able to obtain funding from the National Health Security Office of Thailand, which enables him to train pharmacists who wish to provide smoking cessation services and provide reimbursement to their pharmacies for the pharmacists counseling efforts and medications (which are now nicotine replacement gum and nortriptyline). Dr. Katha said the difficulties of this program are that these is no funding to promote that pharmacists can provide this service and it is hard to identify patients to enroll. We were able to empathize as this also a common problem we face in the United States. It was very impressive that Dr. Katha has been able to create such an impactful program and continue to expand this program with his own efforts!

Counseling patients

While wrapping up our discussion, Dr. Katha shared that his wife was also a pharmacist and would be happy to speak to us about her high-ranking position in the Thai FDA. We were a little caught off guard though since we had asked before during our visits to many healthcare facilities across Thialand if there was an FDA or similar federal agency in Thailand, and we told that there was not, but there truly is! Dr. Katha’s wife was a very sweet lady and who provided us with lots of information on Thailand’s FDA. The Food and Drug Administration (FDA) oversees food products, medications, household products, traditional medicines, cosmetics, medical devices, and food supplements. The major focus of the FDA is on regulating manufacturing, importing and sale of these products. Products must be manufactured in compliance with the Good Manufacturing Practice. Medication products must also go through a pre-marketing process, where they are registered and approved and then a post-marketing process where and inspector goes out to investigate the products and also ensure that products are only being advertised with the approved advertisement. The FDA in Thailand, while it has similar practices, seems to have a much less stringent and expensive drug approval process than the FDA of the United States and is also much smaller with many small subcommittees overseeing the major activities.

After our full morning of learning at Roen-ya Pharmacy, we had to taxi back to our hotel to tend to Megan’s eyebrow, since the wound dressing has to be changed every 24 hours. Erin did a wonderful job carefully cleaning the area and reapplying new gauze and tape with the very nice supplies Bumrungrad had provided. Due to Megan’s still healing injury and upcoming residency interviews, we treated ourselves to afternoon at the spa in the nearby Siam Discovery Mall. We were completely pampered with the most perfectly executed and affordable manicures and pedicures we have ever received.

Spa day!

Since sitting in a large comfy chair being waited on literally hand and foot is very tiring, we worked up quite an appetite! Trying to make the best of our last meals in Thailand we decided to take a spontaneous tuk-tuk ride from the mall to the restaurant that several blogs and websites claimed to be the BEST pad thai in Bangkok and cannot be reached by Sky Train! The tuk-tuk ride was a really fun way to experience the true traffic and wild drivers of Bangkok and enjoy the gorgeous weather. (Traveler tip: Tuk-tuks are fun, but metered taxis are definitely the more affordable way to get around. The tuk-tuk ended up being much more expensive that an metered taxi even after bartering the driver down to half his original price quote!)

Tuk-Tuk

Our spontaneous quest for pad thai led to even more spontaneous fun! The infamous restaurant Thipsamai wasn’t quite open we got there. There was an army of employees buzzing all around setting up the tables and cookware along the street and they told us they would open at 5 PM, so with about 30 minutes to spare we spotted an adorable looking coffee shop across the road. This turned out to be a coffee shop located in the lobby of a Trip-Advisor award winning hostel where travelers can stay for 400 baht (~$13) a night. We enjoyed our tea and hazelnut frappe in the coffee shop/hostel lobby filled with a bulletin board of travel letters and bookshelves of Thailand travel books. We met two guys from Germany both named Yan, who were sitting next to us sharing travel tips with each other and Corinne, a backpacker from California. She walked into the hostel with a freshly painted henna tattoo on her arm. All three of our new friends were craving Pad Thai too, so when 5 PM rolled around we all walked over together and jumped in the line that had already formed to wait for our turn to taste the deliciousness.

Not open yet!

Opening

So. Much. Pad. Thai.

Niras Bankoc Hostel and Coffee

The five of us enjoyed eating a the small table along the street and sharing Pad Thai and travel adventure stories together. One of the Yans had just arrived in Bangkok from a few months in Australia and even came to dinner with a fork in his pocket because he doesn’t like using chopsticks! We were impressed! The menu at Thipsamai isn’t very big and offers only a few versions of Pad Thai (shrimp or vegetarian). We both opted for the delicately egg-wrapped shrimp version and while it was very good we still think our ‘pad thai lady’ at the Talla Noi in Maha Sarakham has the BEST IN THAILAND, (hers just has more flavor!).

Bangkok's best Pad Thai

Our new friends! Loved this spontaneous dinner party!

We said farewell and safe travels to our friends and grabbed a taxi back to the hotel, with a little stop at Swensen’s in MBK across from our hotel for some scoops of macademia nut ice cream of course!

Tuesday morning we woke up and watched our last sunrise over Bangkok from our 11th floor window as we got ready for our last day of block 7 rotations and last full day in Thailand. We enjoyed a great breakfast from the buffet in the hotel lobby and resourceful Erin bought cups of ice from a street cart outside for 5 baht a piece and made us take-away iced coffees for our taxi ride to Roen-ya Pharmacy.

Take-Away iced coffee. 30 cents for BOTH. Going to miss this.

Dr. Katha was not there for our second day at Roen-ya, but we had a great day learning from the pharmacist Dr. Im (which means full in Thai) who graduated from Mahasarakham University’s Faculty of Pharmacy. Dr. Im instructed us just to look at the products in the pharmacy during the morning and then said he would lead a discussion in the afternoon. We enjoyed looking through the pharmacy shelves behind the counter and noticing that most of the herbals and medications organized by indication were manufactured in Thailand or imported from Germany or Switzerland. There were a few international trade names we didn’t recognize and put our Lexicomp app to work looking up several medicines including Glibenclamide (gylburide) and Aescin (horse chestnut used for swelling due to venous insufficiency). Dr. Im was kind enough to answer our questions about what a lysozyme 30mg tablet would be used for. The answer is that is a natural enzyme used for inflammation, nasal congestion, and sore throat when a patient prefers a natural remedy. Dr. Im explained that the mechanism of action is not well understood and also showed us a few other enzymes products such as Proctase-P for tosilitis. When asked what one the big thing that patients come in and ask him about, Dr. Im told us that they want to identify what medicines they are taking that they have purchased elsewhere. Dr. Im uses the MIMS (Master Index of Medical Specialities) Indenta Product Identification Chart, but says that so many capsules and tablets in Thailand have no distinguishing marking that he is usually unable to identify them and often has to recommend that the patient simply stop taking and select a new medication to recommend to the patient.

It was then time for a lunch break and for Dr. Im to get a few more things done around the pharmacy, so we wandered to the post office around the corner to mail one last post card to Megan’s Grandma who enjoys writing and receiving letters. It is only 15 baht (~50 cents) to mail to the USA. The post box had two options for mail, "Bangkok" and "Other Places," which we got quite the kick out of. Across the street and a few blocks down was the Big C supermarket center which had a food court where we had our last lunch in Thailand. Feeling adventurous, we both tried the roasted duck fried rice, which came with the delicious and simple peppery broth we love. We felt extra cool and local walking through and eating in this area of Bangkok called the Khlong San District, as the streets were bustling and the city was alive!

When we got back to the pharmacy after lunch, Dr. Im sat down with us and did a great job teaching us about the three other special projects that they do at Roen-ya Pharmacy and also taught us how they conduct a patient interview and make medication recommendations. First, Dr. Im described the Health Screening Project they conduct. At Roen-ya Pharmacy they can screen any patient over the age of 15 years old for diabetes, hypertension, and obesity. The pharmacist can input the screening data into an Internet program managed by the National Health Security Office and then be reimbursed 40 baht (~$1.30) for each report they submit. They can submit up to three reports per patient, the first being the initial screening report, the second the intervention report, and the third the follow-up report. The pharmacy typically screens 5 patients a week and primarily patients come and receive screening here because they have seen the monitoring instruments (blood pressure cuff, glucose meter, etc.) in the pharmacy or have heard from a friend. Also, the pharmacy can receive a 40 baht reimbursement if a pharmacists provides counseling and education to female patients on oral contraceptives and emergency contraceptives or if they offer a referral for a patient to get a pap smear, provided the pharmacists submits the education and referral reports. It is neat to see that pharmacists are able to be reimbursed for their clinical services in Thailand and also that the importance of always making sure you “document document document” as we are taught at the HSOP is universal in healthcare.

Next, Dr. Im described the Home Health Project that they conduct from Roen-ya Pharmacy for 6 to 7 areas in the Khlong San District (he was even nice enough to draw out a map for us!). The pharmacy collaborates with the local community leaders and healthcare volunteers to identify and visit patients at home who have chronic disease. The pharmacist or 6th-year pharmacy students (the last year in the Thai curriculum) on rotations speak with the patient, complete a through interview, and develop a care plan using the Home Health Packet. This packet includes the number of times the patient was visited, an informed consent page, a map of patients home, the patient's social history, past medical history, medication history, monofilament test record, vitals and lab values if available, and pharmacist counseling profile. The pharmacist then inputs all the data into an Excel form and can be reimbursed 800 baht (~$25) from the National Health Security Office. Pharmacists and pharmacy students from Roen-ya were able to complete visits and make positive interventions for over 150 patients in the area last year. Again, we were impressed by the engagement of Roen-ya Pharmacy in community health endeavors and the support from a national office to recognize the value in care that the pharmacists are providing.

Map of the streets that the pharmacy visits for MTM services/

Home Health Care in Khlong San District

After a few breaks for Dr. Im to provide medications to patients that entered the store, we were ready for our final topic discussion of patient interview and counseling. Dr. Im described that the first step when a patient presents with symptoms of a common illness is differential diagnosis. He told us that most commonly, patients present with an assortment of symptoms such as fever, runny nose, sore throat, muscle pain, and cough which he grouped as "URI" or upper respiratory infection symptoms. He then let us put our clinical skills to the test and come up with a list of possible illnesses the patient could be experiencing from allergies to pneumonia. Then, he walked us through how to make a differential diagnosis. For example, between influenza and dengue fever (a mosquito-borne virus), you look for more severe muscle pains and a higher fever with red spots appearing after a few days with dengue fever and this would require referral to the hospital. If you had come to conclude that a patient had tonsillitis due to swollen lymph nodes and visible pus on the tonsils, you would then follow guideline recommendations to assess if the patient needed an antibiotic. A huge problem is Thailand is infections and resistance to antibiotics, because the 8,000 community pharmacies that don't have pharmacists on-site at all times over-dispense antibiotics to patients that simply have a sore throat.

After differential diagnosis, the next part of the patient interview is called “WWHAMAD” which means you ask the patient Who, What, How, Any other problems, Medications, Allergies, and Diseases. We enjoyed sharing how we are taught the similar SCHOLAR MAC (Symptoms, Characteristics, Hisotory, Onset, Location, Aggrevating Factors, Remitting Factors, Medications, Allergies, Conditions) method for conducting patient interviews. After gathering all information that you can from the patient, you are ready to make a recommendation that is the safest, most efficacious, and affordable for the patient. For tonsillitis, the pharmacist would provide you with the 1st-line medications amoxicillin or penicillin V. Azithromycin or cephalosporins would be considered second line. Dr. Im told us that in two years he has only dispensed 30 antibiotics as a pharmacist because he will only dispense to patients who have a clear infection or have a written paper from their physician that states they need an antibiotic. He doesn’t want to contribute to the over-prescription of antibiotics and create resistance. We agreed with his practice!

After saying our farewells and thank yous to Dr. Im, we headed back in the taxi to our hotel. This time we had a fun taxi driver who kept saying, “You love Thailand? I love Thailand!!” and we would respond, “We love Thailand!” To celebrate the end of block 7 and really just an excuse to have them one more time, we each got one of the incredible mango smoothies from the café in the little side street by our hotel before heading up to our room to pack. Words can't describe the heavenly taste of these amazing treats. We spent the rest of the day singing along to Erin’s awesome playlist of music (the same playlist we made for the roadtrip to climb the mountain a few weekends ago) and reminiscing over our treasures and souvenirs while we packed our bags! All of our belongings and new additions fit and we are hoping the weigh-in at the airport tomorrow will go well! For two girls who did a lot of shopping, packing was surprisingly flawless.

We finished the day out by blogging and catching up on emails in the hotel lobby. We then stepped out on the streets of Bangkok for our last snack/dinner adventure. We opted for banana rotee from a streetcart by our hotel, which was wonderfully warm and sweet. We walked all the way to Siam Paragon where we entered the most incredible food court we have ever seen! We couldn’t believe we hadn’t experienced this yet during our time in Bangkok. This food area has restaurants, coffee shops, and dessert places from all over the world. (Travel tip: If you’re craving Subway, Mexican food, frozen yogurt, Krispy Kreme, burgers, and many other American foods in Bangkok this food area has it all!) We just decided to continue our snacking and walking plan and got Erin her first taste of Chicago’s famous Garrett’s popcorn! This fancy mall had a small version of this store, and it was funny that Erin was introduced to American culture in Bangkok.

Caramel Macadamia Nut (left) and Buttery Classic (right)

Our last stroll back to the hotel was bittersweet. We both are immensely grateful for this life-changing and inspiring opportunity to study and travel across Thailand and feel that Bangkok is our favorite ‘big city’ in the world. Erin is now definitely going to respond to the question “Where are you from?” with “I’m from Bangkok!”

Fan-wan (sweet dreams in Thai) from Bangkok one last time! Looking forward to making our last post when we’re back in the United States after living February 4th for 31 hours! Time is so relative!

Khab kun ka (thank you in Thai) for following along on the adventure of our lives! We can’t wait to see where our pharmacy paths take us next!

Monday, February 2, 2015

Our weekend began promptly at 7:30 AM on Saturday when our private tour guide, Miss Kate, met us in the lobby of our hotel for our tour of the ancient capital of Ayutthaya, Thailand. Ayutthaya is actually the second of 4 capital cities in the history of Thailand, also called Siam (first was Sukothai, then Ayutthaya, followed by Thornburi, and now Bangkok) and was declared in 1991 a UNESCO World Heritage Site, meaning it bears an exceptional testimony to a civilization. We opted to use Travel Hub again since we had such a pleasant experience with this company during our Chiang Mai trekking tour. We also decided to spend a little extra money for the private guide because we both love learning about the history of the things we are seeing. It was WELL worth it!! You can find our tour information here.

Ayutthaya

After greeting Miss Kate, we got in a cute little silver sedan operated by our driver for the day, Mr. Seven. The inside of his car was an early morning delight as it boasted pink ambiance lighting and two large black leather bucket seats instead of a typical back seat. This sounds like a silly perk, but there was a trashcan in the car and they provided us with cold water from a cooler in the trunk all day! The weather in Bangkok the past two days has been really hot and muggy, so we really appreciated this.

Our ride for the day!

The tour began in Bang Pa-In Royal Palace, also known as the Summer Palace for the Royal Family. It is mostly a tourist site now, as the current King of Thailand is very old and unable to travel often. King Buhmibol or Rama IX, has been on the throne 68 years, making him the world’s longest reigning monarch! The Summer Palace is located on the Chao Phraya River bank in Bang Pa-In district, Ayutthaya Province, which was about an hour from our hotel. Since we knew we were facing a bit of a drive and we had slept in a little too much for breakfast, we asked Miss Kate if she wouldn’t mind taking us to get some coffee first. She proved to be an amazing tour guide right from the beginning when she immediately took us to Starbucks, where our iced hazelnut lattes got our morning off to the best start. As an added bonus, we also found dark chocolate covered macadamia nuts. YUM!

Bang Pa-In Palace

Upon entering the Palace grounds, we first stopped at a small stone pagoda near one of the many ponds that was built in Cambodia style, known as a Prong. This structure really stood out because the rest of the Palace complex is very European in design. King Rama V, or more commonly known as King Chulalongkorn, designed it as such so that the Thai people could be exposed to European culture. There is one building that was built after the king’s death in the middle of the lake to honor the structures of the Thai Grand Palace in Bangkok. Inside this gorgeous Thai design is a statue of King Rama V. The actual Palace was gorgeous, but we were not allowed to take pictures inside to preserve the privacy of the Royal Family. The inside was very European as well, except for a large throne that is purely Thai and even is framed by large ivory tusks! We learned that thrones for kings have 9-tiered umbrellas (like the 9 layers of Buddha temples because the King and Buddha are on the same level), while princes and princesses have 7 and 5, respectively. Perhaps our favorite moment of exploring the house though came when we were approaching it and passed under a mango tree with new fruit and blooming flowers. We celebrated this moment by buying some fresh mango from the vendors when we were leaving the Palace as well. We swear we don’t remember fruit being this delicious at home!

Cambodian pagoda

Palace grounds

Inside is the statue of King Rama V

Mango Tree!

While strolling the well-manicured grounds, we saw bushes shaped like elephants and quite a large live relative of a komodo dragon walking around near the lake. We then passed an adorable small pink garden building where groundskeepers can prepare all of the fresh flowers arrangements when the Royal Family visits. Next, we came to a graceful tower that was built by King Rama V, so that he could watch for wild elephants. We climbed to the top of the stairs but sadly didn’t see any elephants roaming! We did overlook the gorgeous Phar Thinang Wehart Chamrun building though, which translates to Royal Residence of Heavenly Light. This Chinese-style two-story mansion was built by the equivalent of the Chinese Chamber of Commerce and presented to King Chulalongkorm in 1889. It was the favorite residence of King Vajiravudh, Rama VI, when he visited Bang Pa-In Palace. We couldn’t take pictures inside, but the carved furniture inlaid with mother-of-pearl was breathtaking! Everything was also brilliant red and gold, the Chinese colors for good fortune.

Elephant bushes on the grounds

Flower prep house

Elephant watching tower

Phar Thinang Wehart Chamrun

The final monument we visited inside Bang Pa-In Palace was constructed for Queen Sunandha Kumariratana, the Queen of King Rama V, who died tragically in a boating accident when she was only 20 years old and pregnant at the time. This was a sad, but beautiful area of the Palace.

After leaving Bang Pa-In our next tour stop was in Ayutthaya at Wat Yai Chai Mongkhol (which means Auspicious Victory), a monastery built by King U-Thong in 1357 to honor King Naresuan the Great for his victory over King Maha Uparacha of Burman in 2135 BE. The ancient temple grounds feature an amazing Reclining Buddha, which is the posture of Buddha depicting his achievement of nirvana. There is a legend that if you hold a coin to the feet of this Buddha and make a wish, your wish will come true if the coin sticks without glue. Both of our coins stuck, and we were quite excited again about the great possibilities before us in 2015! This monastery also boasts a prominent chedi that is 62.1 meters tall and was built with 28,144 tons of brick. We climbed up into the center, where eight golden Buddhas surround a well. The entire inside glistens because Thai people stick gold leaf paper to every facet of the temple for good luck.

Our coins stuck!

You can also walk around the top of the temple around the steeple of the chedi (only clockwise though for good luck) where you have a breathtaking, birds-eye view of the monastery walls. Here, hundreds of Buddha images line the walls and are adorned with gorgeous gold cloths. The cloths draped on the Buddha images are those that were donated by Thai people to make merit with Buddha. We also observed the typical ritual the people perform to Buddha images, which involves incense, flowers, and candles. Three incense sticks are burned to pay respect to Buddha, Buddha’s teachings, and the monks. The flowers symbolize a beautiful life, and the candles symbolize illuminating your life. We also learned that you should always explore a temple clockwise for good luck! Walking counterclockwise only occurs during funeral services. This entire complex was one of our favorite sights that we have seen so far in Thailand!

Next we journeyed to Wat Maha That, the historical park of Ayutthaya. 33 Kings reigned supreme from Ayutthaya, from 1351-1767. Wat Maha That was the royal temple and most scared in Ayutthaya during the glorious time. When Siam lost a fifty-year, intensely bloody war with Burma in 1767, the ancient capitol was abandoned in ruins. Years and years later, citizens and government officials came to restore these historic ruins into a national park. When they did, they discovered the head of a sandstone Buddha image buried in the mangled roots of a Banyan a tree! It has remained untouched ever since and it one of nature’s miracles! We had to kneel in order to take a picture in front of it, because it is disrespectful to stand above the head of Buddha. Walking through these ruins was pretty incredible. Megan also commented on how it’s interesting that we call them ruins when there is nothing ruined about them, they are true works of art. It reminded Erin a lot of Rome and the juxtaposition of ancient temples tucked into a modern city.

Our final stop of the Ayutthaya tour was Wat Phra Si Sanphet, the only temple inside the complex of the Grand Palace of the Ayutthayan Kingdom that did not have resident monks. There was a model of the old Palace inside the ruins that showed how incredibly large it was during the glorious period of Ayutthayan kings. Mostly ruins now, there are still three impressive chedis that stand tall and proud. The chedis’ neighboring temple, used to house a 16-meter tall Buddha image that was destroyed during the Burmese attack. In honor of this Buddha image, Phra Mongkhon BoPhitsits next door to the ruin site in a more modern (but still ancient) Thai temple. It is one of the largest bronze Buddha Images of Thailand. These bronze images are really built with brick, cast in bronze, and then decorated with gold. It was built early in the Ayutthaya period and stands 12.45 meters high. It’s restoration of a lost arm from the Buddha image was complete in 1957.

Wat Phra Si Sanphet

Phra Mongkhon BoPhit

A day in Thailand always brings not only wonder at the big things, but so much joy in the little things. Today was no exception, for we had the fortune of seeing an elephant walk down the street again as we drove up to Wat Phra Si Sanphet. There was also a local market next to the last ruins that our tour guide walked us through for an afternoon snack. We found these "Ba Bin", or sweet coconut sticky rice cakes. They were amazing! We're still in awe how after this long here we can still find good new foods to try and are so glad we’ve journeyed to so many different areas of this country to see and discover local arts and flavors.

Life is about the little things :)

Ba Bin

The tour ended with a cruise down the Chao Phraya River back to Bangkok (Chao Phraya means King’s River in Thai). We boarded in Nonthaburi Province and disembarked for Bangkok, which meant we cruised for around two hours. In true Thai hospitality fashion, the entire crew of the ship was so gracious and accommodating. We were immediately presented with ice water and a fancy dining table for two, as well as a water view! The lunch buffet set up was unbelievable. Some of our favorite items included fried coconut fish, sushi, individual mini mango sticky rice desserts, steamed vegetables, and sliced beef. They also had tea and coffee available upon request, and festive boat drinks served with orchids! Erin even befriended the sweet bartender girl and helped create a new pineapple coconut frozen concoction.

While sailing along the river, we passed some of the homes of the current prince and princesses. We also saw many temples, Thai houses, and restaurants. It was interesting to see livelihood set up right on the river. Our international journey continued as a kind Austrian couple asked us to take their picture and we learned he was an Austrian chemist! It was neat to meet people from yet another country and talk healthcare, science, and education.

As we sailed into Bangkok, we were able to get a stunning view of Wat Arun from the riverbank. We also saw the Grand Palace and caught a glimpse of Sky Bar! This was cool since we took so many pictures of the river from Sky Bar about a month ago, and now we have a whole new perspective. Mr. Seven, our driver, met us at the pier when the boat docked, and it was a short journey back to our hotel for the evening.

Wat Arun

View of the luxury hotels and Sky Bar from the River

We have been experiencing so much that we were honestly exhausted when we arrived back at the hotel! After checking some emails, we both decided that a movie and pizza night would be so perfect if only we could arrange it. Never fear…we’re resourceful when need be! Erin remembered our friend Mint telling us that anywhere in Thailand you can dial 1112 and connect to The Pizza Company. Sure enough, it worked! They already knew our location from our call and were willing to deliver to the hotel within 30 minutes! One Hawaiian pizza coming right up! Erin also wandered down to the hotel lobby to seek a microwave to pop popcorn while Megan downloaded a movie off iTunes. We opted for The King and I, the story of an English woman who journeys to Siam to teach the children of King Rama IV or King Mongkut. We thought it was quite appropriate for our historic day in Thailand, and we both love a good love story! We also can’t believe we’re missing the Super Bowl, so even though we were a day early, we’re glad we joined the projected 12.5 million pizzas that will be ordered today back home.

For Sunday, we had nothing planned but sleeping in and heading back to Chatachuk Weekend Market to finish buying souvenirs for everyone back at home. We were excited for an uneventful, relaxing girls day. The morning started off great with a breakfast of coffee and jackfruit that we had bought fresh off the street the night before. A little after 9:00AM, we headed out of the hotel to the BTS Sky Train station that is literally in front of the hotel doors. Since we had planned to go all the way to Chatachuk (the last stop, called Mo Chit, on the Sukhumvit line) and then journey the opposite direction on Sukhumvit toward the Thong Lo station for dinner, we decided to purchase one-day passes instead of individual fares. It is 130 Baht for the day pass so we definitely saved money this way! Erin was really craving a jasmine tea and Megan was feeling an espresso frappe for the ride, but unfortunately none of the vendors at our station (National Stadium) were open in the morning. We rode the train two stops down and got off at the Phaya Thai station, a busier area, for our drinks at a local coffee shop next to the station. Much to our surprise, when we went to get back on the train, the guard stopped us. We forgot there is absolutely no food or drink allowed on the Sky Train! Begrudgingly, we walked back down the stairs and back into the shop to sit and finish our drinks. We were ready to get our shop on!!

The jasmine bubble tea that started it all...

When we finished our drinks, we looked around for trashcans but faced a very common problem around Thailand, and that is a serious lack of public trash receptacles. Therefore, we approached the coffee counter inside the shop to hand our cups to the sweet girl who had made our drinks. Turning to leave, we were hit with one of the few doors we’ve seen in Thai restaurants. Most everything is an open-air concept and we have gotten so used to that! So quite literally, Megan smacked right into the glass door, because we did not even realize it was there. The force of impact split the skin above her eyebrow, but the door was fine! Erin (Megan’s hero) immediately went into Mom-mode, sat her down, obtained a washcloth, antispectic (in Thailand this is ammonium and witch hazel based), and some bandaids and went to work to contain the bleed. By a fortunate miracle, not a single drop of blood got on Megan’s adorable outfit. However, the cut was deep and definitely required stitches. Thank goodness we had visited Bumrungard International Hospital on Friday and knew we were very close to world-class healthcare.

We told the coffee shop owner we wanted to get to Bumrungard and we were surprised when she hopped in the car with us. After she paid for the driver, we realized she had brought us to the closest hospital, which also looked very nice but we weren’t 100% sure about their ability to treat international patients. We explained that we wanted to go to Bumrungard due to our American insurance, and the sweet shop owner insisted on covering all of Megan’s medical bills. In Thailand, there is no questions asked about who was at fault. They simply take care of everyone, from commoner to celebrity. It is truly an amazing culture. We felt so bad for making the shop pay for such a silly accident, and we wanted to be able to call home and file appropriate paperwork, so we graciously thanked the shop owner and continued to Bumrungard.

ER

Upon arrival, we entered the Emergency Room and explained what had happened. Within 5 minutes, they had referred Megan to a doctor in the outpatient clinic building. They told us exactly what to do: go to the 10th floor to register as a new patient, and then continue to the 16th floor to see the doctor. After registering (an extremely easy process!) and admiring Megan’s awesome International Patient card, we traveled up to the 16th floor and had quite a laugh when we realized we were in the Department of Plastic Surgery! The nurses working this outpatient facility were incredibly kind, and to Erin’s delight there was free jasmine tea in the waiting area. They apologized profusely that we had to wait and see a doctor, and we honestly had no idea what to say because to us, the whole process had been so quick and smooth thus far. In the meantime, sweet and brave Erin went to the gift shop to surprise Megan with an adorably soft teddy bear wearing a green Bumrungrad Hospital hoodie to help her through what would come next (Megan has since named the bear Khoa Dan after Erin since this is her Thai nickname!). The Thai surgeon, who saw Megan within 20 minutes, was incredible and did confirm that she needed stitches. He completed the local surgery within the next half-hour. His bedside manner was fabulous as he talked to Erin calmly the whole time about pharmacy and medicine. He also let Erin sit at Megan’s side throughout the entire procedure to hold her hand (again Megan’s hero!). When he was finished, the nurses (wearing beautiful silk!) gently dressed the wound and taught Erin how to change the dressing. Megan will have to get the stitches taken out in 7 days once we return home, but there should be absolutely no scar!

After checking her blood pressure one last time (107/94…what a champ) we were guided to financial services and the pharmacy. These two check-out services were linked, and after a very pleasant check-out with the billing department, Megan stepped over to the pharmacy department on this flow and was provided with Keflex, paracetamol, chloramphenical ointment, pharmacy counseling, wound tape, and 7 wound dressing kits. This was all presented in a super nice Bumrungard Hospital bag that is honestly nicer than a Bloomingdale’s shopping bag!

Erin preparing Megan's dressing

We were so, so surprised at the quality, efficiency, and affordability of this whole endeavor. The coordination of care was outstanding and we gained a great appreciation of the convenience of receiving medications at discharge and not having to fill prescriptions or obtain medical supplies on our way home from the hospital. The only things we noticed that we would have like to have been done were confirming her blood type and medication history in the ER. They did check for allergies and prior surgical history. Also, they didn’t perform a mental status or neurological exam, but Megan was extremely functional when we walked into the ER. Erin had preformed a Mini Mental Status Exam in the taxi, so we felt pretty okay (her three words to remember were coffee, macadamia, and jackfruit, :) ).

Hospital lunch AKA comfort food

Needing to take a moment to process what had all just happened and a little lunch (plus a few tears and a hug) we stopped at Au Bon Pain in the lobby of the Outpatient Clinic Building. Bagels and cream cheese have never been more comforting! A mere 12 stitches and two hours after the event first occurred, we were back on the Sky Train heading to the hotel to regroup and email our parents.

2 internal and 10 external stitches! She's a rockstar!

We were determined not let this little bump get in our way, so after our email break we made Chatachuk Weekend Market attempt #2 of the day, which turned out to be incredibly successful! We made it all the way to Mo Chit station this time and into the mayhem of this huge, busy market! Since we had been here before we looked for familiar landmarks and found our ways to the stalls we had been waiting to return to in order to bring gifts home. Again, our Thai bartering phrases came in handy for discounts and we came away with many great gifts and treasures!

To make sure we got the most out of our Sky Train day pass and our last days in Thailand, we dropped our two large shopping bags back off at the hotel and at 7PM ventured via the Sky Train to Sukhumvit Soi 38 just off the Thong Lo station on the Suhkumvit Line. Erin found an awesome blog about the best Thai food in Bangkok, which acclaimed that Suhkumvit Soi 38 had the best street food. We agree 100% with this blog and recommend any future Bangkok visitors make their way here! We had a great time walking down this street, taking in the vast amount of vendors and incredible display of menus. We opted for a little street-side restaurant that seemed to have it all. We ordered three of our favorite dishes, massaman curry (a mild conconutty curry with chicken and potatoes), khao soy (chicken and tender mushrooms in a coconut milk broth), and stir-fried cashew chicken. These were delicious and it was fun to eat family style in the open air, just as we did in Maha Sarakham. We also got our beloved Pa Thong Ko (fried dough) with pandan sauce for breakfast from this restaurant. Then to our delight we saw a streetcar filled with more mangoes than we have ever seen and the cute vendor was rapidly slicing through the pile to make mango sticky rice desserts. We of course got a take-away mango sticky rice and were thrilled to have two of our favorites for breakfast the next day. (Note: mango sticky rice doesn’t keep well when refrigerated for leftovers! We wish we would have saved a little room after dinner to be able to eat this as dessert the night before!)

Sukhumvit Soi 38

Going to miss seeing coconut in the fridge like it's normal

This weekend has been filled with being captivated by the splendor of the old and experiencing many new and very unexpected things, but seeing the good in it all, especially good friendship! We are looking forward to our last few days of our International rotation at Roen-ya Community Pharmacy and savoring our last days of adventure in this wonderful city!